JP5432267B2 - Surgical training equipment - Google Patents

Description

  The present invention relates to a surgical training apparatus used for training of a surgical operation, particularly a vascular anastomosis.

  In recent years, surgery has made tremendous progress with significant technological innovation. As a result, surgical techniques have become increasingly complex and specialized, and the experience and skill of the surgeon have been more strongly demanded than ever before. One of the techniques that is heavily placed on the operator's arm is vascular anastomosis.

  As an operation for performing vascular anastomosis, for example, there is a coronary artery bypass operation performed on a patient having a new ischemic disease such as myocardial infarction. This is an operation in which the heart is exposed and an anastomosis is made to a bypass blood vessel for sending blood from another blood vessel to a coronary artery where stenosis is caused, which is a cause of ischemia. This is recognized as a method that can maintain the revascularization effect over a long period of time.

  In addition, lymphatic venule anastomosis for lymphedema, cerebral vascular anastomosis performed for some cases of cerebral infarction or cerebral ischemia due to Willis arterial occlusion (Moyamoya disease), etc. Etc.

  By the way, until now, an apparatus for training surgical suture technique has been disclosed as a surgical suture trainer (see, for example, Patent Document 1).

Japanese Patent Publication No. 60-35150

  In the surgical suture instrument disclosed in the above-mentioned Patent Document 1, the object to be sutured is a cloth-like member, which can contribute to anastomosis training for stitching blood vessels and blood vessels in actual surgery. In addition, there is a problem that it cannot be a practical simulation and practice training of a highly difficult surgical operation in which the blood vessels to be sutured and the blood vessels to be sutured are different from each other.

  Therefore, in order to increase the level of skill in surgical operations, especially vascular anastomosis as described above, it is difficult to improve the skill efficiently and effectively in addition to gaining actual surgical experience. .

  The present invention has been made paying attention to the circumstances of the medical education field as described above, and the skill of the technique is efficiently and effectively acquired before gaining clinical experience in highly difficult surgical operation, particularly vascular anastomosis. An object of the present invention is to provide a compact surgical training apparatus that can be improved.

The present invention, in order to solve the above problem, a surgical training apparatus for simulating and practicing vascular anastomosis, a groove is provided for holding the supporting lifting platform, the first pseudo blood vessel a fixed holding member are, a movable holding member for holding the second pseudo blood vessel to be anastomosed prior Symbol first pseudo blood vessel, wherein the support table is self supports the whole of the surgical training device A support portion that is disposed above the support portion and connected to one end of the movable holding body, and a concave portion that is disposed above the connection portion and engages the fixed holding body. has been fixed holding member mounting portion and the said movable retaining member which is connected to the connection portion at one end, a distal end portion of the second pseudo blood vessel is supported by the other end, before Symbol first and axial direction of the first pseudo blood vessel in an arbitrary position in the pseudo blood vessel There is provided a surgical training device, characterized in that the movable in any direction relative to.

At this time, the movable holding member may the prior SL inserted through so the holding shaft portion in the tube hole of the second pseudo blood vessel to fix the axial direction.

Then, the groove of the fixed holding body may plurality Ru according to prior Symbol diameters of the first pseudo blood vessel.

Further, the movable holding member may is moved to an arbitrary position of the second pseudo blood vessel provided with a flexible arm of the articulated.

  Here, the movable holding body alternately includes a dumbbell-shaped connector member having balls at both ends of a cylinder, and a cylindrical body in which the balls of the connector member are fitted and rotatably hold the balls. A flexible arm portion having a structure in which a plurality of them are connected is provided.

  According to the surgical training apparatus of the present invention, it is possible to reproduce an environment closer to a clinical experience with a simple configuration, and before the actual surgical experience is gained, the mutual angle between the sutured blood vessel and the sutured blood vessel is changed. It can contribute to practical simulation and practice training of surgical operations with different difficulty.

  Moreover, since the structure is simple, it is very compact and inexpensive, and can be easily introduced into the medical education field.

1 is an overall schematic view of a surgical training apparatus according to a first usage pattern of the present invention. It is a disassembled perspective view which shows the outline of the support stand and the 1st holding body in the surgical training apparatus shown in FIG. It is a schematic diagram which shows the outline of the 2nd holding body in the surgical training apparatus shown in FIG. It is a schematic diagram which shows the outline of the flexible arm part in the surgical training apparatus shown in FIG. It is a schematic diagram which shows the example of the holding member provided with two or more grooves. It is a schematic diagram which shows the example of the end side anastomosis in the blood vessel anastomosis. It is a whole schematic diagram of the surgical training apparatus which concerns on the 2nd usage type of this invention. It is a schematic diagram which shows the outline of the 1st holding body in the surgical training apparatus shown in FIG. It is a schematic diagram which shows the example of the end end anastomosis in the blood vessel anastomosis. It is the whole surgical training apparatus schematic concerning the 3rd usage pattern of the present invention. It is a disassembled perspective view which shows the outline of the support stand and fixed holding | maintenance part in the surgical training apparatus shown in FIG. In the 3rd usage pattern of this invention, it is a schematic diagram which shows the example which does not use a holding member. It is a schematic diagram which shows the other example of a pressing plate. It is a schematic diagram which shows the usage method of the holding plate of FIG.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.

[First usage pattern]
In this usage pattern, a case will be described in which the surgical training apparatus of the present invention is used for training to perform an end-to-side anastomosis between pseudo blood vessels (an end of one blood vessel is anastomosed to the side of the other blood vessel; see FIG. 6).

  FIG. 1 is an overall schematic diagram of a surgical training apparatus according to a first mode of use of the present invention. FIG. 2 is an exploded perspective view showing the outline of the support base and the first holding body in the surgical training apparatus shown in FIG. 1, and FIG. 3 is a schematic view showing the outline of the second holding body.

  As shown in FIG. 1, the surgical training apparatus 10 according to the present usage form includes a support base 100 and a first pseudo blood vessel (or artificial blood vessel) BV1 fixedly held on the uppermost surface of the support base 100. A holding body (fixed holding body) 110 and a second holding body (movable holding body) 120 connected to the support base 100 and movably holding the second pseudo blood vessel (or artificial blood vessel) BV2. Is done.

  The support base 100 includes a support portion 101 that supports and supports the entire training apparatus 10, a connecting portion 102 for connecting the movable holding body 120, and a fixed holding body attaching portion 103 for attaching the fixed holding body 110. doing.

  The support unit 101 has a structure that can stably support the training apparatus 10 without falling even if the movable holding body 120 is moved to various positions and postures. More preferably, a non-slip (not shown) made of silicon or the like is provided on the bottom surface.

  The connecting portion 102 is a flange-like projecting portion to be connected by a fixed portion 121 of the movable holding body 120 described later.

  The fixed holder attaching portion 103 includes a concave portion 104 provided on the upper surface of the support base 100 and a screw portion 105 provided on the outer periphery of the concave portion 104 in order to fit a holding member 111 of the fixed holder 110 described later. Become.

  The fixed holding body 110 includes a holding member 111 for mounting the first pseudo blood vessel BV1, a fixing portion 113 for fixing the holding member 111 to the fixed holding body mounting portion 103 of the support base 100, and the holding portion. The holding plate 111 is positioned between the member 111 and the fixing portion 113 and prevents the holding member 111 and the first pseudo blood vessel BV1 from being displaced.

  The holding member 111 is preferably composed of a member having elasticity, and a groove 114 for mounting the first pseudo blood vessel BV1 is formed on the surface thereof. 1 and 2, the holding member 111 having only one groove 114 is illustrated, but a plurality of grooves (two in this example) 114a and 114b are provided as shown in FIG. The holding member 111A may be used. In such a case, the grooves 114a and 114b are made to have different groove widths and groove depths in order to correspond to various sizes of artificial blood vessels (or artificial blood vessels).

  The holding plate 112 is a flat plate-like member that holds the circumferential portion of the holding member 111 and the end portion of the first pseudo blood vessel BV1 and has an opening 115.

  The fixing portion 113 has an opening 116 on the upper surface, and a screw portion 117 that is screwed with the screw portion 105 of the support base 100 is formed on the inner peripheral surface thereof. Therefore, while the first pseudo blood vessel BV1 is exposed from the opening 116, the circumferential portion of the holding member 111 and the end portion of the first pseudo blood vessel BV1 can be pressed together with the pressing plate 112 and fixed to the support base 100. .

  The movable holding body 120 includes a fixing portion 121 for connecting and fixing the movable holding body 120 to the connecting portion 102 of the support base 100, a flexible arm portion 122 formed of a freely deformable material or structure, and a second The holding shaft portion 123 that holds the pseudo blood vessel BV <b> 2, and the connection portion 124 that connects the flexible arm portion 122 and the holding shaft portion 123.

  The fixing part 121 is preferably made of a clip as shown in FIGS. Although not shown, an anti-slip material such as silicon may be provided on the inner side of the clip (the side that contacts the connecting portion 102 of the support base 100). With such a clip, the connecting portion 102 of the support base 100 protruding in a flange shape is sandwiched, and the movable holding body 120 is fixed to the support base 100.

  The flexible arm portion 122 is formed of a material or a structure that can be freely deformed and can maintain the deformed state so that the second pseudo blood vessel BV2 can be arranged at an arbitrary position and angle. Here, as an example, a structure in which ball joints as shown in FIG. The details are shown in FIG. As shown in this figure, here, the flexible arm portion 122 is configured by a ball joint structure in which a dumbbell-shaped connector member 126 including a ball 126A and a shaft 126B and a cylindrical member 127 are strongly fitted so as not to drop off. The Since the balls 126A of the connector member 126 freely rotate in the cylindrical body 127, they can be bent and extended. Fine adjustment of position and angle is easy.

  The holding shaft portion 123 is composed of a shaft member that holds the second pseudo blood vessel BV2 by being inserted into the lumen of the second pseudo blood vessel BV2. Furthermore, it is preferable to provide a clip 125 that fixes the second pseudo blood vessel BV2 at a predetermined insertion position of the holding shaft portion 123.

  The connection part 124 connects the flexible arm part 122 and the holding shaft part 123. Since the thickness of the blood vessel varies greatly depending on the site (for example, an aorta having a diameter of about 30 mm, a coronary artery having a diameter of about 3 mm, etc.), pseudo blood vessels having various diameters are used for training. Therefore, it is necessary to replace the holding shaft portion 123 according to the thickness of the pseudo blood vessel to be used. Therefore, it is preferable that the connection portion 124 has a structure in which the holding shaft portion 123 can be easily replaced.

  Hereinafter, a case where vascular anastomosis training is performed using the surgical training apparatus 10 having the above configuration will be described.

  First, the first pseudo blood vessel BV1 is fitted into the groove 114 provided in the holding member 111 of the fixed holding body 110, the holding member 111 is inserted into the concave portion 104, the pressing plate 112 is disposed, and the fixing portion 113 is further inserted. Is attached to the fixed holder attaching portion 103. Although not shown, it is preferable that a wire serving as an axis is inserted into the first pseudo blood vessel BV1 arranged in the groove 114 to prevent displacement.

  On the other hand, the second pseudo blood vessel BV2 to be anastomosed with the first pseudo blood vessel BV1 is inserted into the holding shaft portion 123 of the movable holding body 120. At this time, the second pseudo blood vessel BV2 is sandwiched and fixed by the clip 125 together with the holding shaft portion 123 in a state where the second pseudo blood vessel BV2 protrudes from the distal end of the holding shaft portion 123 by a predetermined length. Then, the second pseudo blood vessel BV2 is arranged at an optimal position for anastomosis by the flexible arm portion 122 that freely deforms the second holding body 120.

  As a result, as shown in FIG. 6, the first pseudo blood vessel BV1 and the second pseudo blood vessel BV2 are anastomosed by the suture thread 41 and the suture needle 42.

  As described above, according to the first usage pattern described above, the support base 100 and the fixed holding body 110 are integrated, and the movable holding body 120 that is further freely deformed is provided, so that the surgical training is compact and easy to use. The apparatus can be configured, and end-to-side anastomosis training can be easily performed.

[Second usage pattern]
In this usage pattern, a case will be described in which the surgical training apparatus of the present invention is used for training for end-to-end anastomoses between pseudo blood vessels (an end-to-end of one blood vessel and the end of the other blood vessel; see FIG. 9).

  FIG. 7 is an overall schematic view of the surgical training apparatus according to the second mode of use of the present invention. FIG. 8 is a schematic diagram showing an outline of the first holding body in the surgical training apparatus shown in FIG.

  The surgical training apparatus 20 of this usage pattern has the same configuration as that of the first usage pattern except for the first holding body 210. Therefore, the same parts as those in the first usage pattern shown in FIG.

  As shown in FIG. 7, the surgical training apparatus 20 according to the present usage form includes a support base 100 and a first pseudo blood vessel (or artificial blood vessel) BV1 that is connected to the support base 100 and is movably held. The second holding body (second movable holding body) 210 and the second holding body (second movable holding body) 210 that are connected to the support base 100 and hold the second pseudo blood vessel (or artificial blood vessel) BV2 movably. Holding body) 120.

  Thus, the surgical training apparatus 20 of this usage form can be obtained by simply adding the movable holder 210 to the surgical training apparatus 10 shown in the first usage form. The first movable holder 210 has the same structure as the second movable holder 120 (FIG. 3). That is, as shown in FIG. 8, the first movable holding body 210 includes a fixing portion 211 for connecting and fixing the first movable holding body 210 to the connecting portion 102 of the support base 100, and a freely deformable material. Or it consists of the flexible arm part 212 formed by the structure, the holding shaft part 213 holding the first pseudo blood vessel BV1, and the connecting part 214 connecting the flexible arm part 212 and the holding shaft part 213. The configuration of each of the above parts is the same as that of the second movable holding body 120 shown in FIG.

  Hereinafter, a case where vascular anastomosis training is performed using the surgical training apparatus 20 having the above-described configuration will be described.

  First, the first pseudo blood vessel BV1 is inserted through the holding shaft portion 213 of the first movable holding body. Further, the second pseudo blood vessel BV2 to be anastomosed with the first pseudo blood vessel BV1 is inserted into the holding shaft portion 123 of the movable holding body 120. At this time, the first pseudo blood vessel BV1 and the second pseudo blood vessel BV2 are projected by a predetermined length from the distal ends of the holding shaft portions 213 and 123, and the holding shaft portions 213 and 123 together with the clips 215 and 125. It is sandwiched and fixed. Then, each of the pseudo blood vessels BV1 and BV2 is disposed at an optimal position for anastomosis by the flexible arms 212 and 122 that freely deform the first holding body 210 and the second holding body 120.

  As a result, as shown in FIG. 9, the first pseudo blood vessel BV <b> 1 and the second pseudo blood vessel BV <b> 2 are anastomosed by the suture thread 51 and the suture needle 52.

  As described above, according to the second usage pattern described above, by providing two movable holders 210 and 120 that are freely deformed on the support base 100, a surgical training apparatus that is compact and easy to use can be configured, and easily It is possible to perform end-to-end anastomosis training.

[Third usage pattern]
In this usage pattern, as in the second usage pattern, a case will be described in which the surgical training apparatus of the present invention is used for training for end-to-end anastomosis between pseudo blood vessels. However, here, an example is shown in which the pseudo blood vessel is not held by the movable holding body as in the second usage pattern, but the pseudo blood vessel is held by the fixed holding body.

  FIG. 10 is an overall schematic view of the surgical training apparatus according to the third mode of use of the present invention. FIG. 11 is an exploded perspective view schematically showing a support base and a fixed holding portion in the surgical training apparatus shown in FIG.

  In addition, the surgical training apparatus 30 of this usage pattern has the same configuration as that of the first usage pattern except for the fixed holding part (the first holding body and the second holding body). Therefore, the same parts as those in the first usage pattern shown in FIG.

  As shown in FIG. 10, the surgical training apparatus 30 of the present usage form is provided on the support base 100 and the upper surface of the support base 100, and holds the first pseudo blood vessel (or artificial blood vessel) BV1 in a fixed manner. First holding shaft portion (fixed holding body; first holding body) 310 and second pseudo blood vessel (or artificial blood vessel) BV2 that holds the second holding shaft portion (fixed holding body; second) And a fixed holding unit 300 including a holding body 320. Here, the first holding shaft portion 310 that holds the first pseudo blood vessel BV1 fixedly and the second holding shaft portion 320 that holds the second pseudo blood vessel BV2 fixedly are respectively the first pseudo blood vessel. For example, a U-shaped or L-shaped fixing material (for example, U-shaped or L-shaped) is inserted into the inner surface of each pseudo blood vessel so that the BV1 and the second pseudo blood vessel BV2 do not easily move on the surface of the holding member 301 (see FIG. It is preferable to provide 10 reference numerals 310 and 320 (dotted line portions).

  As shown in FIG. 11, the fixed holding unit 300 includes a holding member 301 for holding the first and second pseudo blood vessels BV1 and BV2, and a first holding shaft portion inserted through the first pseudo blood vessel BV1. 310, a second holding shaft portion 320 inserted through the second pseudo blood vessel BV2, a fixing portion 303 for fixing the holding member 301 to the fixed holding body attaching portion 103 of the support base 100, and a holding member 301 The holding plate 302 is located between the fixing portion 303 and prevents the holding member 301 and the pseudo blood vessels BV1 and BV2 from being displaced.

  The holding member 301 is preferably composed of a member having elasticity, and a groove 304 for placing the first and second pseudo blood vessels BV1 and BV2 is formed on the surface thereof. The grooves provided in the holding member 301 may be provided with a plurality of grooves having different groove widths and groove depths so as to accommodate pseudo blood vessels (or artificial blood vessels) of various sizes. An opening 301 </ b> A is provided at a substantially central portion of the holding member 301 so as not to disturb the anastomosis training. In addition, as shown in FIG. 12, you may make it hold | maintain pseudo blood vessels BV1 and BV2 using the clip 335 instead of using a holding member.

  The first holding shaft portion (fixed holding body; first holding body) 310 and the second holding shaft portion (fixed holding body; second holding body) 320 are inserted into the lumens of the pseudo blood vessels BV1 and BV2. Thus, the shaft member is configured to hold the pseudo blood vessels BV1 and BV2. It is preferable that the holding shaft portions 310 and 320 have a thickness that is optimal for the thickness of the pseudo blood vessel to be used. As shown in FIG. 11, these holding shaft portions 310 and 320 preferably have a substantially L-shape. If it does so, it can insert between the holding member 301 and the inner side of the fixed holding body attaching part 103, and can fix a position easily. Note that the holding shaft portions 310 and 320 may be configured to be fixed to the pressing plate 302 and the fixed holding body attaching portion 103.

  The holding plate 302 is a flat plate-like member that holds the circumferential portion of the holding member 301 and the end portions of the pseudo blood vessels BV 1 and BV 2, and has an opening 305. In addition, the shape which has the protrusion part 308 as shown in FIG. Here, FIG. 13A is a top view of the pressing plate 302A, FIG. 13B is a cross-sectional view taken along the line aa of FIG. 13A, FIG. 13C is a cross-sectional view taken along the line bb, and FIG. ) Is a cross-sectional view taken along line cc. Here, an example is shown in which two sets (308a, 308b) of protruding portions 308 having different lengths are provided, but a plurality of sets or only one set may be provided. The protrusion 308 is provided line-symmetrically with respect to the diameter. FIG. 14 is a diagram illustrating an example of use of the pressing plate 302A. 14A shows a case where the pseudo blood vessels BV1 and BV2 are pressed by the large protrusion 308a, and FIG. 14B shows a case where the pseudo blood vessels BV1 and BV2 are pressed by the small protrusion 308b. A case where pseudo blood vessels BV1 and BV2 are pressed in the interval 309 is shown. As described above, when two protrusions 308 (308a and 308b) having different lengths are provided, the pseudo blood vessels BV1 and BV2 can be pressed at three positions. As shown in these drawings, by forming the protruding portion 308, even when the pseudo blood vessels BV1 and BV2 are short in length, it is possible to reliably hold the end portions.

  The fixing portion 303 has an opening 306 on the upper surface, and a screw portion 307 that is screwed with the screw portion 105 of the support base 100 is formed on the inner peripheral surface thereof. Therefore, while exposing the pseudo blood vessels BV1 and BV2 from the opening 306, the circumferential portion of the holding member 301 and the end portions of the pseudo blood vessels BV1 and BV2 can be pressed together with the pressing plate 302 and fixed to the support base 100.

  As described above, the surgical training device 30 of the present usage configuration can be obtained by making a slight change to the configuration of the fixed holding body 110 of the surgical training device 10 shown in the first usage configuration.

  Hereinafter, the case where vascular anastomosis training is performed using the surgical training apparatus 30 having the above-described configuration will be described.

  First, the first pseudo blood vessel BV1 and the second pseudo blood vessel BV2 are inserted into the first holding shaft portion 310 and the second holding shaft portion 320, respectively, and set on the holding member 301, and the concave portion 104 of the support base 100 is set. After holding the holding member 301 together with the holding shaft portions 310 and 320, the holding plate portion 302 and the fixing portion 303 are used for fixing. At this time, the first pseudo blood vessel BV1 and the second pseudo blood vessel BV2 are fixed in a state where the first pseudo blood vessel BV1 and the second pseudo blood vessel BV2 protrude from the tips of the holding shaft portions 310 and 320 by a predetermined length.

  As a result, as shown in FIG. 9, the first pseudo blood vessel BV <b> 1 and the second pseudo blood vessel BV <b> 2 are anastomosed by the suture thread 51 and the suture needle 52.

  As described above, according to the third usage pattern described above, the support base 100 and the fixed holding members 310 and 320 are integrated to form a compact and easy-to-use surgical training apparatus, and the end-to-end anastomosis can be easily performed. It becomes possible to perform training.

  Although the use form of the present invention has been described above, the present invention is not limited to the use form described above, and various modifications can be made based on the spirit of the present invention, and these are excluded from the scope of the present invention. is not.

  The present invention relates to a surgical training device used for training surgical procedures, particularly vascular anastomosis, and has industrial applicability.

10, 20, 30 Surgical training apparatus 100 Support base 101 Support portion 102 Connection portion 103 Fixed holding body mounting portion 104 Recess 105 Screw portion 110 First holding body (fixed holding body)
111, 111A Holding member 112 Holding plate 113 Fixing part 114, 114a, 114b Groove 115, 116 Opening 117 Screw part 120 Second holding body (movable holding body)
121 Fixed portion 122 Flexible arm portion 123 Holding shaft portion 124 Connection portion 125 Clip 126 Connector member 126A Ball 126B Shaft 127 Cylindrical member 210 First holding body (first movable holding body)
211 Fixing part 212 Flexible arm part 213 Holding shaft part 214 Connection part 215 Clip BV1 First pseudo blood vessel (or artificial blood vessel)
BV2 Second pseudo blood vessel (or artificial blood vessel)
300 fixed holding portion 301 holding member 301A opening 302 holding plate 303 fixing portion 304 groove 305, 306 opening 307 screw portion 308, 308a, 308b protruding portion 309 between protruding portions 310 first holding shaft portion (fixed holding body; first holding body; Holding body)
320 2nd holding shaft (fixed holding body; second holding body)
335 clips

Claims (5)

A surgical training device for simulating and practicing vascular anastomosis,
A support base;
A fixed holding body provided with a groove for holding the first pseudo blood vessel;
A movable holding body for holding a second pseudo blood vessel that is anastomosed to the first pseudo blood vessel,
The support base is
A support part for supporting and supporting the entire surgical training apparatus;
A connecting part disposed above the support part and connected to one end of the movable holding body;
A fixed holding body mounting portion disposed above the coupling portion and having a recess for fitting the fixed holding body;
Said movable holding member being connected to the connection portion at one end, of the second pseudo blood vessel is supported by the other end of the tip, before SL and the first at an arbitrary position in the first pseudo blood vessel A surgical training apparatus characterized by being movable in any direction with respect to the axial direction of a pseudo blood vessel. It said movable holding member is pre Symbol surgical training apparatus according to claim 1 which is inserted a retaining shaft portion in the tube hole of the second pseudo blood vessel, characterized in that fixed in the axial direction. Wherein the grooves of the fixed holding member, the front Symbol surgical training device according to claim 1, characterized in that it is plurality in accordance with the diameter size of the first pseudo blood vessel. It said movable holding member is surgical training device according to claim 1 which comprises a flexible arm part articulated to said and Turkey moving the second pseudo blood vessel at any position. The flexible arm portion connects a plurality of the joints including a dumbbell-shaped connector member having balls at both ends of a column and a cylindrical body in which the ball of the connector member is fitted and rotatably holds the ball. The surgical training apparatus according to claim 4 , wherein the surgical training apparatus is a structured structure.

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